We certainly appreciate very much the work that the team with the Health Quality Council of Alberta (HQCA) did to investigate what has been accomplished since the recommendations made in the first report the Continuity of Patient Care Study. Greg died May 19th, 2012 of a blood clot, in our family home after a series of breaks in the continuity of care throughout the health system. The 2013 report, utilized Greg’s fatal journey to identify gaps in Alberta’s health system and to quote Dr. Tony Fields, HQCA Board Chair,
“We believe this report and its recommendations can move us in the right direction, so that healthcare providers are enabled to ensure coordinated care, and all patients experience a seamless journey throughout the health care system.”
The HQCA carefully investigated what they could of the events leading up to Greg’s premature death and produced the original Continuity of Patient Care Study that was released on December 19th, 2013. Alberta Health Services also did an investigation, but their report has never been made public.
In the fall of 2015, Dr. Carl Amrhein, Deputy Minister of Health, requested the HQCA to do a follow up study to determine what progress had been made on the first report’s recommendations. The report titled Improving Continuity of Care: Key Opportunities and a Status Report on Recommendations from the 2013 Continuity of Patient Care Study is the result.
We are grateful to Dr. Amrhein for asking the HQCA to do this investigation, to report and to provide new recommendations and in many cases, a potential road map to make meaningful progress. We took it as a great signal that there is commitment to insure the recommendations were going to be implemented and the reduction and elimination of similar harm happening to future patients in Alberta.
It is evident in our examination of the report, that our experiences as a family and experiences we are aware of from many other Albertans, that while there has been limited progress in some areas, in others there has been very little.
The main body of the report focuses not on all thirteen previous recommendations but looks at four of them “in the interest of focusing discussion on progress and opportunities in those areas thought to have the greatest potential to improve continuity of care system wide…”
We agree that electronic medical records, electronic referral and patient portals are foundational components of a modern health care system. While we recognize that some progress has been reported, it has been many years to get to this point and the current path indicated anticipates at least another decade to get a single provincial Clinical Information System. This is far too long and far too costly a process not only financially but for the health of patients.
While we understand the perspective on the report’s recommendations, we believe the public needs a solution(s) that embraces innovation and takes advantage of rapid improvements in technology including, for example, the integration of personal health apps. This would enable and empower patients to be partners in their own care.
The report goes on to look at the area of critical test results management. Again it is good to hear that there has been some attention paid to this topic. Incredibly the report notes that the AHS analysis found “180 possible failure points with the current structures and processes”. It is positive news that AHS is reported to have developed the outline of the work to be done. Now it is important to know how quickly these failure points will be eliminated.
The report’s comments on the Provider Registry are straight forward and obviously supportable.
Standards of Practice were also looked at in this report and how they affect continuity of care. We appreciate the work that the College of Physicians and Surgeons of Alberta (CPSA) did last year to establish the new Continuity of Care Standard of Practice. We also know that good work has been done to evaluate the compliance level of their members. It was a concern to us to hear that compliance levels were, and remain, unacceptably low. We know that the CPSA has communicated to all physicians through its newsletter the need to reach minimum standards, and yet, compliance has not really improved. A few months ago we were disappointed to learn at that point, there was no plan to take further steps to insure patients would have all doctors meeting their college’s minimum standard. We look forward to news of a disciplined plan to reach this goal.
The Appendix I of the report provides a very valuable assessment of all 13 recommendations from the December 2013 Continuity of Patient Care Study. It is worth a closer look by anyone that wants to see what has and has not changed.
While many individual providers and some groups have learned from the 2013 report and from Greg’s Journey described on the HealthArrows website, it is evident in this 2016 report that there is much more to be done. Dr. Tony Fields, in the forward of the current report states “A steady hand and commitment to a focused path can bring Alberta’s healthcare system to a state in which continuity of patient care is supported and enabled.” We say that it is time for action on the part of the leadership when now, after nearly 3 years, the authors report 11 of 17 actions identified from the original 13 recommendations have “moderate” or “high risk” of not reaching full implementation and 3 more “have had no work completed and no path identified for implementation”.
We strongly support the report’s advice to empower the existing Health Quality Network (HQN), which is made up of virtually all leaders of the different system parts, to:
- “monitor progress on the implementation of advice in the report and outstanding recommendations from the original report
- to report to the public and to the Deputy Minister.”
In fact we would go one step further by saying that the HQN should be held accountable for the implementation of these recommendations in the time frame that reflects the real public urgency to reduce the preventable pain, suffering and death of Albertans occurring now.
Our family has identified three key priorities we would like to see implemented in order to move our health system to where it should and it must be. Simply stated, these are:
- A major culture reset and rapid transition to a genuine teamwork driven system across all provider “silos” as well as vertically throughout. Teamwork that includes patients as a key player and decision maker.
- A system of insuring electronic medical records for and available to every patient and their providers along with electronic referral system to coordinate patient care and keep all team members informed and appropriately engaged with the patient in our care.
- A comprehensive and disciplined system with a strong sense of urgency insuring everyone learns from “near misses” and adverse events in order quickly eliminate repeat occurrences.
Finally, we believe that it is very important that all members of the public to look more closely at the state of our health system and join in with and support the wonderful people inside the system who are dedicated to make the needed change to create the team based, high performing, constantly improving system we should have. Without the public’s engagement, priorities for the critical and long overdue changes will not reach the top of the pile. This is clearly evident from the latest report where we see evidence there of reluctance and indeed resistance to the changes needed. The “system” has too many people comfortable and “stable” while many patients and families suffer needlessly. We the healthy public must drive new action.